Individual provider Active NPI

Catherine K Ellyn, MD

  • Anesthesiology Physician
  • Charleston, SC
National Provider Identifier
1013963560
Registry record updated May 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
14577 Issued in SC
Practice address
125 Doughty St
Ste 420
Charleston, SC 29403
Phone
(843) 723-3441
Fax
(843) 805-4040
NPI assigned
May 26, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 14577 SC Primary

Addresses

Primary practice location

125 Doughty St
Ste 420
Charleston, SC 29403

Mailing address

PO Box 22206
Charleston, SC 29403-2206
Phone (843) 723-3441

Other practice location 1

2095 Henry Tecklenburg Dr
Charleston, SC 29414-5733
Phone (843) 402-1436

Other identifiers 1

IdentifierTypeStateIssuer
145774MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110527000268 SC Practitioner - Anesthesiology 3476730532 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Medical University of South Carolina College of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bon Secours St Francis Xavier Hospital IncGroup PAC ID 8325008717, 202 clinicians

Practice addresses (Care Compare)

2095 Henry Tecklenburg Dr
Charleston, SC 29414-5733
Phone (843) 402-1436

Hospital & facility affiliations

  • Roper Hospital Hospital, Charleston, SC, CCN 420087

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Bon Secours St. Francis Xavier Hospital, Inc. Anesthesiology CurrentSince Apr 30, 2020 Accepting new patients
Bon Secours St. Francis Xavier Hospital, Inc. CurrentSince Apr 30, 2020 Accepting new patients
Bon Secours St Francis Xavier Hospital, Inc. Current Accepting new patients
Anesthesia Associates of Charleston, P.a. Anesthesiology CurrentSince Jan 1, 1997 Accepting new patients
Anesthesia Associates of Charleston, P.a. PastSince Jun 21, 2020 Accepting new patients

Locations

1064 Gardner Rd
Ste 112
Charleston, SC 29407
Phone (843) 723-3441

125 Doughty St
Ste 420
Charleston, SC 29403
Phone (843) 723-3441

2095 Henry Tecklenburg Dr
Charleston, SC 29414
Phone (843) 402-1037

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715558400000",
    "number": "1013963560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22206",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294032206",
            "telephone_number": "843-723-3441",
            "fax_number": "843-805-4040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 DOUGHTY ST",
            "address_2": "STE 420",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "29403",
            "telephone_number": "843-723-3441",
            "fax_number": "843-805-4040"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2095 Henry Tecklenburg Dr",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "SC",
            "postal_code": "294145733",
            "country_code": "US",
            "telephone_number": "843-402-1436",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLYN",
        "first_name": "CATHERINE",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-26",
        "last_updated": "2024-05-13",
        "certification_date": "2024-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "SC",
            "license": "14577",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "145774",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

Verify at the official NPI Registry.